摘要
目的 探讨心瓣膜置换术后心室颤动 (VF)发生的高危因素及其可能的防治措施。 方法 回顾性收集96 8例心瓣膜置换术患者的临床资料 ,按术后是否发生 VF分为两组 ,VF组 :5 8例 ,术后均发生 VF;对照组 :从 910例未发生 VF的患者中随机选择 70例作为对照。选择术前临床指标、超声心动图 (UCG)、心肺转流术 (CPB)、心瓣膜病变类型和术式、术后 2 4小时循环及电解质状况等指标 ,用 L ogistic回归方法分析术后发生 VF的高危因素。 结果 年龄≥ 6 5岁、心胸比率≥ 0 .8、NYHA心功能 级、急诊或再次手术、主动脉阻断时间≥ 12 0分钟、术后 2 4小时循环不稳定、低钾、低镁等电解质紊乱是其发生的独立危险因素。 结论 VF是心瓣膜置换术后的早期严重并发症 ;患者的年龄、心脏基础病变的严重程度、围术期的处理可以影响术后 VF的发生 ;早期手术、缩短主动脉阻断时间、维持术后2 4小时内循环稳定、防止电解质紊乱和缺氧、酸中毒的发生 ,是预防心瓣膜置换术后 VF发生的有效措施。
Objective To explore the risk factors of ventricular fibrillation(VF) after cardiac valve replacement, and discuss its possible preventive methods. Methods Nine hundred and sixty-eight patients who had undergone cardiac valve replacement procedure were reviewed and divided into two groups according to whether VF appeared after operation. VF group including 58 cases who had VF after operation; control group including 70 cases taken from 910 cases by random who had no VF occured on. The clinical data, indexes of ultrasono-cardiography(UCG) and cardiopulmonary bypass (CPB), kind of valvular disease and methods of operation, circulatory and electrolyte status of postoperative 24 hours, were selected and the risk factors of VF were analysed with Logistic regression method. Results Age≥65 years, cardiothoracic ratio (CTR)≥0.8,heart function (NYHA) Ⅳ grade, emergency operation or reoperation, aortic-crossclamping time≥120 min, circulatory failure and electrolyte disorder as hypokalemia, hypomagnesemia in postoperative 24 hours were independent predictors of postoperative VF. Conclusion VF remains the severe early complication after cardiac valve replacement, patient's age, degree of basic pathological change of heart, and perioperative management can influence the incidence of VF, early operation, shortening of aortic-crossclamping time, maintaining of normal circulation and electrolytes and prevention of anoxia/acidosis, may be the most effective preventive method of VF after cardiac valve replacement.
出处
《中国胸心血管外科临床杂志》
CAS
2002年第3期161-164,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
